Posts Tagged ‘minimally invasive procedures’

In our last blog, Dr. John Douglas discussed Coronary Artery Disease (CAD). Now, we will cover a new procedure to treat CAD, called Hybrid Revascularization, that we are performing at the Emory Heart & Vascular Center.

Currently, Emory is one of the few centers in the country offering this procedure. Standard guidelines call for patients with blockages in the left main artery (the artery that provides most of the blood to the heart) to undergo bypass surgery.

Hybrid revascularization’s advantage is a combination of coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI). Emory physicians are leaders in performing these procedures “off-pump” in a minimally invasive fashion, without breaking open the chest.

The minimally invasive CABG procedure uses robotic-assisted techniques that allow surgery to be performed using small incisions between the ribs rather than through a midline incision dividing the sternum.

The recovery from robotic assisted CABG is shorter and expected to have fewer complications. Impressively, most patients are able to leave the hospital within three to four days and return to full activity, including work, in two to three weeks rather than the two-month recovery generally required following traditional CABG.

This approach is a “best of both worlds strategy”- minimally invasive off-pump left internal mammary artery (LIMA) graft plus a stent placed via ultrasound from the left main to the left circumflex artery.

For more a case study about this procedure view the March issue of The Chamber, our heart and vascular e-newsletter.

About Dr. Halkos
Dr. Halkos is a cardiothoracic surgeon at the Emory Heart & Vascular Center. He specializes in cardiovascular disease, coronary artery bypass surgery and valve repair/replacement. He finished his Medical School, Residency and Fellowship at Emory University School of Medicine. He is a member of the American Medical Association.

As part of our commitment to providing the best patient-centered care possible, our team of physicians, nurses, specialists, and staff make advancing the medical possibilities a priority each and every day. There are only so many factors we can control, however, and sometimes, it is perfect timing coupled with the efforts of our team that make treatment for our patients that much more successful.

Take Allen Owens, for example. He may be someone you’re familiar with if you frequent our heart & vascular blog. We introduced you to him in a post a few weeks back detailing his remarkable story. Prior to arriving at Emory, Allen experienced 8 heart attacks, 21 congestive heart failures, had 13 stents placed, had 5 bypass surgeries (4 of them failed) and had taken 4 life flights (emergency helicopter rides to the hospital). On each life flight he was not expected to make it to the hospital because of his critical status.

It may sound like Allen faced a run of unfortunate health bad luck. After all, he did what he could to prevent a decline in his health. He’s not a smoker or a drinker, and considered himself to be a relatively healthy adult.

Perhaps surprisingly, it was when his local doctors were out of answers that Allen’s life (and luck) changed for the better. He was referred to Emory and last summer, received another diagnosis to add to his plate – Allen’s abdominal aorta was weakening and he had developed an aortic aneurysm that was ballooning and could burst at any time. You may be wondering, what’s lucky about that? The majority of aortic aneurysms are found after they burst, and fortunately, doctors caught Allen’s prior to this happening.

What’s more, Allen’s health wasn’t strong enough to undergo another heart surgery to repair the problem. Once again, Allen’s luck was changing for the better. At about the same time that Allen was diagnosed with his aortic aneurysm, Dr. Joseph Ricotta, a vascular surgeon, had just transitioned his career at the Mayo Clinic to working at Emory Healthcare. At the Mayo Clinic, Dr. Ricotta had perfected a new procedure to treat aortic aneurysms, an alternative aortic aneurysm treatment he brought with him to Emory– the use of fenestrated and branched aortic endografts, a procedure Dr. Ricotta has performed approximately 120 times thus far.

Six months after performing this revolutionary procedure for Allen, Dr. Ricotta told Fox 5 News the graft is working perfectly, “The aneurysm’s shrinking actually. There’s no evidence of leak and all the branches to his intestines and kidneys are open and look very good.”

The procedure and Dr. Ricotta’s presence in Atlanta have hopefully put an end to this Cherokee County native’s run of bad luck. It’s Allen’s hope now, that with his condition under control, he will be able to qualify for a heart transplant. “This will be eight years in April, that I’m not supposed to have,” Allen told Fox 5 News.

You can learn more about the fenestrated and branched aortic endograft procedure for aortic aneurysms, and learn more about the story of Allen Owens by watching this video from Fox 5 News below:

Transapical aortic valve implantation (AVI) is a minimally invasive technique that replaces the aortic valve through the placement of a small incision under the left breast—directly below the heart—without using cardiopulmonary bypass. It’s designed for patients who do not have appropriate sized femoral vessels in the groin for the treatment of aortic stenosis.

Transapical AVI is actually a type of transcatheter valve implantation. There are two ways to go about this sort of implantation: through transapical or transfemoral routes (a transfemoral procedure involves an incision in the groin area).

Transapical AVI is often referred to as an “off-pump” procedure, as routine surgical aortic valve replacement (AVR) requires that the breastbone be opened, and patients must be placed on a heart lung machine. Conversely, transapical AVI doesn’t involve opening the breastbone, nor does the procedure require utilization of the heart lung machine; hence the term “off-pump.”

So, why would a surgeon opt for transapical AVI, as opposed to transfemoral AVI? If a patient has too much calcium in their arteries or groin, this prevents us from being able to insert catheters in these areas, creating a case for transapical AVI.

Some of the typical candidates for this procedure include patients with severe aortic stenosis, or those who have blockage of the aortic valve. However, some patients do not qualify for this procedure, particularly for the purposes of the trial that Dr. Block mentioned in his last post. These include patients who are on dialysis, or who have had previous valve surgery. That said—we do anticipate that these parameters may change, potentially in late 2011.

Emory is truly a “one-stop-shop” in that we offer a multitude of services for the treatment of aortic stenosis: minimally invasive AVR, transcatheter AVI (transfemoral or transapical), off-pump left ventricle to descending aorta bypass, or balloon aortic valvuloplasty. We are truly fortunate to be able to provide all of these services for our patients.

If you have any questions about transapical AVI or any of the numerous procedures we offer at Emory Heart & Vascular, please feel free to let me know in the comments section, or call me at 404-686-2513.

About Vinod H. Thourani, MD:

Dr. Thourani specializes in minimally invasive valve surgery (including mitral valve repair and replacement and aortic valve surgery) and transcatheter valve surgery (transfemoral and transapical aortic valve implantation). He also performs other facets of adult cardiac surgery including on and off-pump coronary artery revascularization and atrial fibrillation surgery. He completed his general surgery residency, cardiothoracic residency, and cardiothoracic surgical research and clinical fellowships at Emory University. Dr. Thourani joined Emory as a faculty member in 2005.

At Emory, we are constantly pushing the boundaries of modern medicine in an effort to discover safer, more effective ways of healing patients. At Emory Heart & Vascular, we’ve made remarkable strides in minimally invasive coronary artery bypass surgery (CABG) through the use of robotic technology.

Our minimally invasive CABG procedure utilizes a robotically assisted endoscopic technique, allowing the procedure to be performed with small incisions between the ribs, as opposed to opening the chest through splitting the breastbone (median sternotomy).

One of the many advantages of robotic-assisted CABG is that it doesn’t require the use of a heart-lung machine, or cardiopulmonary bypass, and can be performed without dividing the ribs or sternum. Therefore, the recovery from the procedure can be considerably shorter, and may be associated with a lower risk of some complications. Most patients are able to leave the hospital in as few as three days, and may return to normal activities in two-three weeks, as opposed to two-three months—the recovery time period generally associated with traditional CABG surgery.

Robotic-assisted CABG is most often performed on patients with single-vessel coronary artery disease. However, the procedure can be part of a hybrid approach for patients with multi-vessel disease. With a hybrid revascularization approach, surgeons work together with interventional cardiologists to combine the benefits of surgery with the benefits of stenting. Typically, the surgeon will perform a single-vessel robotic-assisted CABG for a blocked artery on the front of the heart, and cardiologists can perform a stenting procedure to the other blocked vessels.

Emory has been performing minimally invasive CABG since 2003, and is one of only a few medical facilities in the country offering the procedure.

Do you have questions about this or any other procedure at Emory Heart & Vascular? If so, please feel free to let me know here in the comments section.

About Michael E. Halkos, MD:

Joining the faculty in July 2009, Dr. Halkos received his MD and did his general and cardiothoracic surgical training as well as a two year research fellowship at Emory. He is currently Editor of the Resident Section of CTSNet and serves on the Executive Committee of the Thoracic Surgeons Residents Association. His clinical specialties include off-pump coronary artery bypass surgery, valve repair/replacement surgery, and minimally-invasive valve and coronary surgery, and his research interests are stroke after cardiac surgery and surgical outcomes.

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